Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 91-100 (doi:10.1542/peds.2005-2343)

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Neuropsychological Outcome of Children With Intrauterine Growth Restriction: A 9-Year Prospective Study

Ronny Geva, PhD^a, Rina Eshel, PhD^b, Yael Leitner, MD^b, Aviva Fattal Valevski, MD^b and Shaul Harel^b

^a Institute for Child Neurology and Neurology Unit, Dana Children’s Hospital, Souraski Medical Center, University of Tel Aviv, Tel Aviv, Israel
^b Psychology Department, Developmental Neuropsychological Laboratory, Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel

OBJECTIVE. The aim was to evaluate the effect of late-onset intrauterine growth restriction on the neuropsychological profile and on academic achievements at 9 years of age using a large-scale prospective paradigm.

STUDY DESIGN. We followed up 123 infants diagnosed with late-onset intrauterine growth restriction yearly for 9 years. They were matched with 63 children for gestation age and multiple socioeconomic factors and evaluated by an extensive neuropsychological battery to assess intelligence quotient, academic achievements, learning and memory, visuomotor skills, visuospatial integration, attention, language, executive functions, and creativity.

RESULTS. Children with intrauterine growth restriction had lower intelligence quotient and more frequent neuropsychological difficulties. Difficulties in executive functioning, inflexibility-creativity, and language, indicative of frontal lobe dysfunction, were typically affected by intrauterine growth restriction and were rarely identified in the control group. Learning difficulties accompanied by lower academic achievements were more prevalent in the intrauterine growth restriction group, particularly when anthropometric catch-up was incomplete.

CONCLUSIONS. The longitudinal findings reaffirm that functional coherence depends on preestablished structural growth and reorganization of the central nervous system. The neuropsychological profile at 9 years of age indicates that late-onset intrauterine growth restriction compromises frontal network functioning.

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Key Words: outcomes of high-risk infants • neurocognitive • long-term follow up • executive function/dysfunction • intrauterine growth retardation

Abbreviations: BSP—brain-sparing process • CI—cephalization index • IUGR—intrauterine growth restriction • BW—birth weight • CNS—central nervous system • IQ—intelligence quotient • EGA—estimated gestational age • WISC-R95—Wechsler tests of intelligence-revised • ROCF—Rey-Osterrieth Complex Figure • NEPSY—Neuropsycholological Evaluation for Children • HC—head circumference • ANOVA—analysis of variance • NS—not significant • CUG—catch-up growth • AGA—appropriate-for-gestation age

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Accepted Jan 19, 2006.

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